Objective To evaluate the effects of hypothermic cardiopulmonary bypass (CPB) on rocuronium-induced neuromuscular blockade in the patients undergoing open heart surgery.Methods Twenty ASA physical status Ⅰ or Ⅱ patients,scheduled for elective open heart surgery,aged 18-45 yr,with body mass index of 18-25 kg/m2,were randomly assigned into 2 groups (n =10 each) using a random number table:room temperature group (group R) and hypothermia group (group H).The nasopharyngeal temperature was maintained at 30-31 ℃ during CPB in group H or at 36-37 ℃ during CPB in group R,and it was maintained at 36-37 ℃ before and after CPB in both groups.Anesthesia was induced with iv etomidate 0.3 mg/kg,fentanyl 2-4 μg/kg and rocuronium 0.3 mg/kg.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of sufentanil and intermittent iv boluses of midazolam and fentanyl.BIS value was maintained at 40-60.Neuromuscular block was monitored using TOF-WATCH SX accelerometer.Train-of-four stimulation (intensity 40 mA,frequency 2 Hz,wave length 0.2 ms,interval 12 s) of ulnar nerve was used.Rocuronium was infused intravenously using an automatic feedback control system to maintain T1 at 8％-12％.At 10 min after start of operation (T0),10 min after onset of CPB (T1),and 10 min after termination of CPB,blood samples were collected for determination of the plasma concentration of rocuronium (by HPLC).The infusion rate and consumption of rocuronium were recorded before,during and after CPB.Results Compared with group R,the plasma concentration of rocuronium was significantly decreased at T1,2,and the infusion rate and consumption of rocuronium were decreased before and after CPB in group H.Conclusion Hypothermic CPB enhances rocuroniuminduced neuromuscular blockade in the patients undergoing open heart surgery.

Objective To probe into the influencing factors of selecting the intravenous vascular access device for tumor patients undergoing intravenous therapy? Methods With convenience sampling,376 tumor patients in oncology department from 3 hospitals of class A hospitals in Guangzhou were selected for the survey including such 6 categories with 41 items as general data, patient’s willingness,punctured blood vessels,use of vascular access and clinical conditions? Results In 124 patients,peripheral venous catheter was used (33?0%)? Central venous catheter was used in 252 patients (67?0%),Multiple linear regression analysis showed that way for paying the expense,vascular conditions for venous punctuation,phased diagnosis,decision of the doctors,and prospected duration for detaining catheter significant influencing factors? Conclusions The state should raise their medical allowances for those with lower incomes? The administrative should enhance the training to doctors and nurses at grass levels,promote the communication between medical workers and patients and improve their recognition of transfusion devices so that they can make a right choice?

For a matured digestive surgeon,pancreaticoduodenectomy (PD) is regarded as one of the most complicated and technically challenging surgical procedure.Based on the accurate interpretation of patient's preoperative imageologic data,we advocate a novel procedure which is called as G-path pylorus-preserving pancreatoduodenectomy (G-path PPPD).We deen G-path PPPD as a standardized procedure for resectable pancreatic head cancer or periampullary carcinoma,which definitely simplify the procedure,save the operative time,achieve R0 resection through en-bloc resection without interruptedly intraoperative exploration and reduce the risk of iatrogenic tumor metastasis.This article introduced the program of G-path PPPD in detail by taking a patient as an example who suffered from pancreatic head cancer accompanied with obstructive jaundice,and discussed the relevant points.

Objective To evaluate the predictive value of tumor metabolic indexes measured by 18F-FDG PET/CT in recurrence of stage Ⅰ NSCLC after surgery.Methods A total of 85 patients (44 males,41 females,age (62.46± 10.38) years) in Shanghai Renji Hospital with stage Ⅰ NSCLC,who underwent 18F-FDG PET/CT and subsequent surgical resection,were retrospectively enrolled from April 2006 to December 2011.Gender,age,tumor size,pathology,SUVmax,MTV and TLG of the primary tumor were selected as variables.ROC curve analysis was used to analyze the cut off value.The prognostic significance of parameters for recurrence-free survival (RFS) was evaluated by univariate and multivariate analyses.Survival analysis was analyzed by Kaplan-Meier method.Results During follow-up period,tumor recurrence occurred in 21 patients (24.7％,21/85) and 11 patients (12.9％,11/85) died.The median follow-up period was 44 months.The median values of SUVmax,MTV and TLG were 4.100,3.048 cm3 and 7.970,respectively.Cut off values of SUVmax,MTV and TLG were 7.115,4.701 cm3 and 12.015 according to ROC curve analysis.Univariate Cox analysis showed that SUVmax(x2 =22.091),MTV (x2 =4.941) and TLG(x2 =10.488) were associated with RFS(all P＜0.05).But gender,age,tumor size,and pathology were not independent risk factors of recurrence (x2=0.248-3.888,all P＞0.05).Multivariate Cox analysis revealed that SUVmax(=16.902,HR=15.426,P＜0.05) and TLG (x2=6.029,HR=4.054,P＜0.05) were independent prognostic factors for recurrence.Kaplan-Meier survival analysis showed that the period of RFS in high SUVmax (＞ 7.115) group (x2=32.545,P＜0.05) and in high TLG (＞12.015) group (x2=12.665,P＜0.05) were lower than those in low SUVmax group and low TLG group.Conclusion The SUVmax and TLG measured by 18F-FDG PET/CT have significant value for predicting the recurrence of stage Ⅰ NSCLC.

Objective To study the Janus Kinase 2 V617F (JAK2V617F) point mutation in bcr-abl-negative myeloproliferative disorders (MPD) and explore its clinical significances. Methods Genomic DNA was isolated from bone marrow or peripheral-blood granulocytes. Allelespecific-polymerase chain reactions (AS-PCR), restriction enzyme digestion in combination with PCR product sequencing were performed to detect the mutation in genomic DNA. 110 patients were detected, including 41 with bcr-ablnegative MPD, 25 with bcr-abl-positive chronic myelogenous leukemia (CML), and 44 with acute leukemia.Results JAK2V617F was presented in 11 cases(91.7 %) of 12 polycythemia vera (PV), 8 cases(53.3 %) of 15 essential thrombocythemia(ET), 4 cases (57.1%) of 7 idiopathic myelofibrosis (IMF), while in other patients including 7 hypereosinophilic syndrome (HES), 25 bcr-abl-positive CML, 24 acute myelocytic leukemia (AML), 18 acute lymphoblastic leukemia(ALL), and 2 acute mixed lineage leukemia, JAK2V617F can not be detected. All positive samples and 10 negative samples identified by AS-PCR and restriction enzyme digestion were confirmed further by DNA sequencing. Conclusion The frequency of JAK2V617F mutation was more than 90 % among patients with PV, more than 50 % among patients with ET and IMF. The detection of JAK2V617F mutation will be of great significanees in the diagnosis and differential diagnosis of MPD. This mutation can be a molecular marker of MPD and might be a treatment target in the future.

Objective:To investigate the safety and effect of complete mesocolie excision (CME) combined with arterial infusion chemotherapy (AIC) and intra-peritoneal interstitial sustained-release chemotherapy (IPISRC). Methods:A total of 104 patients were classified under the experimental group and underwent CME combined with AIC and IPISRC. The other 98 patients were classified un-der the control group and only received radical surgery. Pre-and post-operative blood routine examinations, as well as liver and kidney function tests, were conducted for both groups. Post-operative adverse reactions and incidence of complications were recorded. Cancer and para-neoplastic tissues were sampled in experimental group. The post-surgery 5-fluorouracil (5-FU) concentration in the drainage fluid as well as those in the peripheral blood , were determined. Three-year follow-ups were conducted, during which the local recur-rence rate, liver metastasis, progression-free survival rate, and total survival rate were recorded. Results: No significant differences were found in the white blood cell count, hemoglobin count, liver and renal functions of the patients before and after the surgery, and rate of adverse reaction and complications between the two groups after surgery (P>0.05). In experimental group , the 5-FU concentra-tion was significantly higher in the cancer tissues than in the para-neoplastic tissues . The 5-FU concentration in experimental group was also significantly higher in the intra-peritoneal drainage liquid and reached its peak in the peripheral blood on day 3 post-surgery . Local recurrence and liver metastasis rates were significantly lower in experimental group than those in control group, whereas the pro-gression-free and three-year overall survival rates were significantly higher in experimental group than in control group (P<0.05). Con-clusion:The tharepy of pations of experimental goup is safe and effective. This method significantly improves the progression-free and three-year survival rates of the patients as well as significantly reduces the local recurrence and liver metastasis rates of colon cancer.

Objective To investigate the perioperative treatment and reduce the surgical risk in patients after pancreaticoduodenectomy (PD).Methods We retrospectively analyzed the clinical data of 213 PD patients operated at the PLA General Hospital from January 2012 to December 2012.Results The postoperative complications included pancreatic fistula (51 cases,24％),biliary fistula (8 cases,3.8％),intestinal fistula (8 cases,3.8％),gastroparesis (35 cases,16.4％),abdominal infection (16 cases,7.5％),and postoperative bleeding (16 cases,7.5％).The perioperative mortality was 1.9％ (4/213).Conclusion Strengthening the perioperative management of PD patients plays an important role in improving surgical safety and reducing postoperative complications.

Objective To investigate the value of partial hepatectomy and vascular resection in the treatment of hilar cholangiocarcinoma. Methods Seventy four patients with hilar cholangiocarcinoma who underwent hepatectomy of Chinese People' s Liberation Army from January 2008 through December 2011 were analyzed retrospectively.Results Of the 74 patients,33 underwent radical resection and 19 palliative resection,22 received internal or external drainage.In the radical resection group,the median survival time was 27 months,and the overall survival rate at 1,2 and 3 years were 79％,64％ and 49％.In the palliative resection group,the median survival time was 14 months and the overall survival rate at 1,2 and 3 years were 56％,25％,and 19％.In the drainage group,the median survival time was 9 months and the overall survival rate at 1,2 and 3 years were 23％,15％,0.Conclusions Hepatectomy combined with hilar vascular resection helps increase survival rate of patients in radical excision of hilar cholangiocarcinoma and Surgical resection is the most elective method for treatment of hepatic hilar cholangiocarcinoma,and the radical resection might improve the prognosis of the patients with hilar cholangiocarcinoma.

Objective: To investigate the value of NPM1 and FLT3 gene mutation combined with bone marrow imaging detection in the prognosis judgement of initial treatment cytogenetically normal acute myeloid leukemia (CN-AML). Methods: The clinical data of 100 patients (non-M₃ type) with primary and initial treatment CN-AML from January 2010 to January 2014 in the Peace Hospital Affiliated of Changzhi Medical College were retrospectively analyzed. All patients were enrolled in the bone marrow imaging examination on the end day of induction treatment or the first day after the end of induction treatment (T time point). Univariate and multivariate prognostic analyses were performed on AML patients according to FLT3 and NPM1 gene status,bone marrow juvenile cell ratio at T time point. Results: A total of 100 patients included 36 cases with FLT3 gene mutation and 44 cases with NPM1 gene mutation. The complete remission (CR) rate of CN-AML patients was 13.9% (5/36) and 71.9% (46/64), respectively (P < 0.01), 2-year recurrence-free survival (RFS) rate was 5.6% and 59.8%, respectively (P < 0.01), 2-year overall survival (OS) rate was 15.6% and 66.2%, respectively in FLT3⁺ group and FLT3^- group (P < 0.01). The median RFS and median OS time in FLT3⁺ group was 6.9 months and 9.4 months, respectively, and the median RFS and median OS time in FLT3^- group had not yet reached. There were no significant differences of all the indexes between the two groups (all P < 0.01). And there were no significant differences in CR rate, 2-year RFS rate and 2-year OS rate between NPM1⁺ group and NPM1^- group (all P > 0.05). The CR rate, 2-year RFS rate and 2-year OS rate in NPM1⁺ FLT3^- group were better than those in NPM1^- FLT3^-, NPM1^- FLT3⁺ and NPM1⁺ FLT3⁺ groups; NPM1^- FLT3⁺ and NPM1⁺ FLT3⁺ groups had the worst prognosis, and there were no statistical differences in the CR rate, RFS and OS time between the two groups (all P > 0.05). The prognosis of the patients in bone marrow juvenile cell ratio < 0.05 group at T time point was better than that in ratio ≥0.05 group (all P < 0.05). CN-AML patients were classified into the good prognosis group (NPM1^- FLT3^-), the medium prognosis group (NPM1⁺ FLT3^-), and the poor prognosis group (NPM1^- FLT3⁺ and NPM1⁺ FLT3⁺) according to the FLT3 and NPM1 genes. The good prognosis group+ the ratio of bone marrow juvenile cells at T time point < 0.05 group, the good prognosis group+ the ratio of bone marrow juvenile cells at T time point ≥0.05 group, the medium prognosis group+ the ratio of bone marrow juvenile cells at T time point < 0.05 group had no statistical differences in CR rate, 2-year RFS rate and 2-year OS rate (all P > 0.05). The medium prognosis group+ the ratio of bone marrow juvenile cells at T time point ≥0.05 group, the poor prognosis group+ the ratio of bone marrow juvenile cells at T time point < 0.05 group had the equivalent prognosis, and the average prognosis was moderate; the poor prognosis group+ the ratio of bone marrow juvenile cells at T time point ≥ 0.05 group had the worst prognosis. According to Cox multivariate regression analysis, FLT3 gene mutation and the ratio of bone marrow juvenile cells at T time point were independent influencing factors for RFS and OS in CN-AML patients (all P < 0.05). NPM1 was an independent prognosis factor affecting RFS and OS of FLT3^- patients (all P < 0.05). Conclusions After induction chemotherapy, the responsiveness and sensitivity of AML patients to chemotherapy regimen can be assessed early and objectively according to molecular genetics and the ratio of bone marrow juvenile cells at T time point, which has a certain value in the prognosis judgement.

Objective To explore the correlation between main indicators of donor liver and early prognosis after liver transplantation.Methods The clinical data of 166 donors and recipients of post-mortem organ donation (DD) from June 2017 to June 2018 were retrospectively analyzed.The effects of donor age,sex,body mass index,serum sodium level,total bilirubin,prothrombin time and international standardized ratio on early allograft dysfunction (EAD) in liver transplant recipients were investigated.According to the culture results of donor liver preservation solution,the results were divided into positive group and negative group.Combined with the culture results of blood,sputum and drainage fluid after liver transplantation,the early infection rate of recipients in the two groups was observed.Results Univariate analysis showed that preoperative donor bilirubin total ＞17.1 mmol/L and donor cold ischemia time ＞8 h were risk factors for postoperative EAD in transplant recipients.Multivariate analysis showed that donor cold ischemia time ＞8 h was an independent risk factor for postoperative EAD in liver transplant recipients;the incidence of EAD in the group with cold ischemia time ＞8 h was significantly higher than that in the group with cold ischemia time ≤8 h (26.3％ vs.7.0％;P =0.003).The positive rate of postoperative sputum culture and drainage fluid culture in the donors with positive donor culture was 43.9％ and 48.8％,respectively,which was significantly higher than that in the negative group (10.7％ and 13.1％).The difference was statistically significant (P =0.000,P =0.000).The positive rate of postoperative blood culture in the positive group and the negative group was 12.2％ and 6.0％ with the difference being not statistically significant (P =0.161).Conclusion Cold ischemia time of the donor ＞8 h is an independent risk factor for EAD in recipients after liver transplantation.Shortening the cold ischemia time of donor liver can reduce the incidence of postoperative EAD in recipients.The culture results of preservation solution have a certain guiding effect on the postoperative anti-infective treatment of the recipients.